Menopausal Moments

The personal question patients used to ask me was “Are you pregnant?” Recently, a patient inquired, after sharing that his wife had started menopausal hormonal therapy, “Do you also take this?”

I have indeed started what I call my Menopause Trifecta: an estrogen patch, a progesterone pill, and a testosterone gel. Estrogen made me miserable during puberty; helped me become a mother of two children; and drove cyclical cravings, cramps, and crying. But my ovaries no longer produce estrogen. My “childbearing potential” is gone. Unused menstrual supplies gather dust in a cabinet.

I recall my mother’s menopause—she endured hot flashes and lamented the dearth of information about women’s health. In response I decided I would age gracefully when my turn came. Back then, I believed that menopause is physiological! That there must be some evolutionary reason for menopause! That it would be so liberating to be without periods!

Two words uttered by a favorite yoga teacher during an early morning class made me re-evaluate. As she described the value of balancing poses in avoiding post-menopausal hip fractures, she added huskily, “I supplement.”

My pre-caffeinated brain exploded and FOMO crept in. My brain fog, fatigue, anxiety, joint pain, and insomnia had been growing as my estrogen levels declined, and I was struggling. My epiphany: Maybe life could be better with hormones.

I am of the generation of physicians who were taught very little about menopause. The Women’s Health Initiative research study muddied the waters about the safety of hormonal supplementation. One physician I know declared, “Not in my wheelhouse. I refer.” Another doctor friend’s commitment to learning about menopause motivated me to educate myself, too, and to consider hormonal therapy. It was disheartening to realize that menopause is the reverse of cis-female puberty. The labia minora shrink and disappear. Vaginal tissue atrophies. Breast tissue is replaced by fatty tissue. And the sucker punch: societal status and visibility depreciates.

I recall an elderly patient who once calmly showed me her prolapsed uterus, wrapped in a blue incontinence pad and tucked securely in her panties! She’d birthed nine babies in a rural village in her homeland, causing her pelvic floor and uterine ligaments to relax to the point of prolapse. Could this be in my future? I have a partial prolapse already and could probably do my own Pap smear.

Having now expanded my knowledge, I am determined to talk with patients about menopause. So many people suffer in silence, stifled by misinformation. Maybe a loss can become a gain?

Pam Adelstein
Newton, Massachusetts